By Julie Cunningham

Technology is often thought of as a modern phenomenon, involving sophisticated methods to bend raw materials to our will. Technologies, however, have been with us since the invention of tools and ritual. The axe and communal dance were technologies, the axe for material effect and dance for relational effect. The philosopher Martin Heidegger (1977), drawing from the original Greek meaning of ‘techne’ as crafts that reveal possibilities, asserts technology is better thought of as a way of revealing or understanding ourselves and the world. As we create, we are transformed. A technology may cause seismic transformations. Such was the arrival of digital technology in the last decades of the 20th century. Prenksy (2001, p. 1) described it as ‘a singularity’, causing fundamental material and relational changes, with no going back.

What digital technologies reveal about humans is still being discovered, but the weave of digital communication technologies (DCT) throughout the world – as well as the discovery of mirror neurons in 1992 (Cozolino, 2006) – redirects the 20th century emphasis on humans as individual consumers (Curtis, 2002) towards humans as essentially relational beings in an interconnected world.

Current data supports this view, with four in five people believing access to the internet is a human right, 63 per cent of the global population now online (Website Data Reportal, 2022) and 82.7 per cent of Australians active on social media (Wearesocial.com, 2022) and averaging an hour per day usage.

Given this uptake of internet interaction, Stadter’s (2013, p. 3) augmentation of the usual question about technology, “What can it do for us?”, to include “What is it doing to us?”, is vital. Our experiences of selfhood, relationships and privacy have been reshaped by DCTs and social media in a multifaceted pattern of effects.

DCT’s effect on mental health

The bullet train of DCT has taken off and, as new devices and apps are created, the psychosocial landscape shifts, often reverberating into the politic – the US ban on TikTok is a case in point (Maheshwari & Holpuch, 2023). The main carrier of these effects is increasingly the mobile phone.

According to Bankmycell.com, in July 2022, 91.54 per cent of world population owned a mobile phone and by 2025, 75 per cent will exclusively use them to access the internet. Considering these statistics on our often-constant companions, impact on the self appears inevitable.

Parallel with the pleasures and benefits we have from using DCT to connect, be entertained, search for information, play games and so on, the continual accessibility available to us also encourages addiction.

Cundy (2015) discusses implications for the development of attachment in infancy if primary caregivers addictively depend on social media for connection and validation, are often distracted, or use mobiles as devices to distract baby. It is true TV has been similarly used for decades by parents, but the addictive nature of accruing social media ‘likes’ too easily creates dopamine addicts, as Walters (2021) and Lembke (2020) argue. In addition, this invisible, ‘seductive other’ that baby may attempt to compete with for attention, is not limited to the living-room.

In the crucial first months of life, base levels of neurohormones are formed through relational processes. Skin-to-skin contact stimulates the production of oxytocin, boosting the immune system. When a primary caregiver is chronically distracted by social media, and neglects to attend to the baby’s need for holding, eye contact and, in general, being affirmed, a child’s sense of self and attachment style will be detrimentally affected (Cundy, 2015, pp. 1–4); (Winnicott, 1965a), later impacting their adult selves.

Beyond mobile addiction, in 1999 Young described five internet addictions – computer gaming, information addiction via web surfing, online gambling and shopping, consuming pornography, or engaging in virtual sex.

While some, such as Jones et al. (2014), argue that video gaming in moderation has positive effects, internet gaming disorder is now included in the DSM (5, Section 3). Social media addiction is not, but relevant references abound in the literature, for instance, by Van den Eijnden et al. (2016) and Andreassen et al. (2012). Social network site (SNS) addiction symptoms include depression, cognitive and emotional preoccupation with the SNS, seeking more usage over time, withdrawal symptoms when use is limited, interpersonal and intrapersonal conflict and, often, relapse after abstinence.

Mobiles also aid citizen journalism and connect people in areas where phone lines were never built. We increasingly rely on them, outsourcing our wayfinding capacity, personal data, connections and our ‘captured memory images’ to them. Many studies, such as that by Walsh and White (2007), affirm that young people’s sense of validation and self-identity are entwined with their use of mobile phones, highlighting how ‘digital natives’ vary in their use of and relationship to mobile devices from ‘digital immigrants’, who matured without this influence.

Nicoli (2015) compares the experience of mobile phones to ‘magic wands’, collapsing the distance between desire and satisfaction, allowing us to find information anytime, anywhere. Dating apps offer unlimited access to the pool of single people, eschewing the need to meet challenges that arise in committed relationships. By swiping left or right on Tinder, aptitudes vital for psychological growth – such as reflecting and integrating new experiences, or connecting with the unconscious in daydreams or imaginings – are often eclipsed. It may be true that humanity is more and more at risk of becoming evacuated (Bion, 1962) due to our ‘magic wands’. Even when together, couples can often be seen engaging with their phones rather than each other. The question arises: What is the primary relationship, with device or human?

Anxiety of varying degrees often occurs when mobiles are lost or not charged. This now has a name, nomophobia (or ‘no mobile phone phobia’), a term coined in 2008 (Bhattacharya, 2019). At its most severe, effects include trembling, agitation, perspiration and disorientation. Nomophobia distress can compound, and be compounded by, other anxieties.

Illustration: Vecteezy

Shambare et al. (2012) suggest cell phones are “possibly the biggest non‐drug addiction of the 21st century”.

The veritable hydra of negative DCT effects has produced a counter measure. Smartphones are now being harnessed to prevent, moderate and lessen anxiety. In a meta-analysis, Firth et al. (2017) found smartphone apps dedicated to psychological interventions can, to varying degrees, reduce anxiety.

Voices for the positive effects of DCT

Weinberger (2014, p. 15) points out DCT negatives are highlighted by academic researchers and parents. Seeking to rebalance this, he focuses on DCT’s benefits for mental and social health. Referring to the discovery of mirror neurons shifting our concept of Homo homini lupus (man is a wolf to man) as aggressive and competitive towards an emphasis on our social brains, cooperation and altruistic behaviour, he asserts the internet helps fulfil our deep need to connect and belong. Further, even if engagement is superficial, it still holds benefits for ‘homorelational’ who desires interaction, exchange of information, and space to express opinions and form relationships. Weinberger debunks the idea the internet is a fraught space, quoting low statistics on bullying or flaming, even for adolescents (Weinberger, 2014, p. 8). Weinberger’s enthusiasm appears almost unlimited, such as his claim that on SNS, social masks need not be worn (Weinberger, 2014, p. 13). This is questionable, particularly in relation to suicidality when people take their lives after appearing happy on Facebook. It is these images that often distract loved ones from the person’s vulnerability.

As well as an impulse to hide depression or suicidality on an SNS, an impulse to reveal has been researched and described as ‘the disinhibition effect’ (Suler, 2004). This may occur due to lack of eye contact, asynchronous communication, dissociative anonymity, invisibility, solipsistic introjection (where another person’s message is experienced like an interior voice), dissociative imagination and minimisation of authority in the online space. Further, online disinhibition may manifest, like other online phenomena, in either a toxic or benign form.

Digital counselling and the positives and negatives of online disinhibition

Adverse implications of DCT disinhibition on therapeutic relationships are discussed by Kaluzeviciute (2020). Where once privacy and confidentiality framed the client, therapist and the therapeutic relationship, a disinhibited client using Google searches, between-session text messaging and emails, mobile access or an SNS, may threaten the frame. Kaluzeviciute sees this having the most impact on psychoanalysis, muddying transference, but the porous digital environment can have implications for other therapists and counsellors. How open do we want to be? Is openness helpful to clients? For vulnerable clients who need the reassurance of a Google search, digital openness may work protectively.

Benign disinhibition manifested beautifully during lockdowns when Zoom and other video conferencing apps (VCA) facilitated interaction between isolated persons, families and friends. Loneliness and boredom were punctured by online parties, and by people inserting themselves inventively into images of classic art works, for instance. DCT revealed its spontaneous, creative, therapeutic potential. Since the pandemic lockdowns, public acceptance of online counselling has grown, and become accepted, valued, promoted and used, widening the scope of our profession. When a client occupies their own personal space in therapy, they can feel more open and relaxed, activating benign disinhibition.

Online psychoeducation, psychotherapy, groups, challenges and virtual reality

Counsellor Trevor Armitage, in a Torrens University Australia video interview, attests to VCAs working for groups of five or six people, as well as for one-on-one therapy, particularly for psychoeducation. In group online psychotherapy, however, when emotions are triggered and body language is obscured, greater challenges arise for a group leader than in a physical space. These challenges can be compounded by needing to monitor the reactions of more than six people, dealing with technical glitches and a therapeutic frame with potentially ‘leaky’ privacy issues.

The use of Zoom and often CBT-focused, course-based e-psychotherapy processes and apps (Weightman, 2020) mean people in rural areas and those with limited time and/or mobility are now better serviced.

Virtual reality (VR), with counsellors using Skype bedecked in VR cartoon avatars modelled on themselves, has also been trialled to address rehabilitation and psychological issues in remote communities. Benign disinhibition was discussed and categories such as presence and co-presence were measured, resulting in VR sessions rating higher than Skype sessions without avatars, which presents hopeful possibilities for distance engagement (Pedram et al., 2020).

Gerontechnology, digital technology and the aged

Gerontechnology is an interdisciplinary field that involves the research and trialling of existing and developing technologies to address the needs of aging and aged adults. The hope and aim for gerontechnology is to be viable and cost-effective for supporting elders in a range of activities. This expanding field includes VR, robots, telemedicine, smartphone apps, video games (VGs) and dedicated software for psychological, social and cognitive engagements and interventions. However, from my research into gerontechnology so far, the role of a counsellor is largely eclipsed or being minimised. Further, in scoping studies such as that of Vailati Ribonis et al. (2020), older adults are often grouped together as a homogenous group. Education, career or cultural experience are not often included in research data. These factors need inclusion, as does user feedback and cultural differences.

Illustration: Vecteezy

The benefits of VR and gerontechnology

Research attests to VR’s benefit for memory and cognition, but wearing a VR headset may be unappealing for some older adults (Optale, 2009). However, when participants used VR while walking on treadmills, their balance and gait improved (Mirelman et al., 2013). VR combined with cognitive behaviour therapy has also been used to address anxiety (Turner, 2014).

Software, video games and gerontechnology

Evidence for the improved wellbeing and cognitive performance of some older adults from software, VGs and smartphone apps has been found (Ball et al., 2002); (Torres, 2008).

The Butler system, dedicated gerontechnology software, was developed by a Spanish team and has been tested and positively accessed (Botella et al., 2009). It provides diagnosis of emotional state, alerts and management reports, mood uplift training and social engagement via chat, videos, photo albums, music, friend forums and internet accessibility.

Literature about VGs for older adults (Toril et al., 2014) is also expanding, suggesting VGs for healthy older adults can improve cognitive functioning and positively effect memory, attention, reaction time and global cognition (Ballesteros, 2015). Importantly, VGs are inexpensive and can be gratifying and fun.

Dedicated social networking sites for young people

Headspace’s 140 physical centres are augmented by a variety of safe and supportive online community spaces where 12 to 25-year-olds can meet, chat, share resources or design their own avatar. Users can also collect and save resources to build their own mental health toolkit and/or speak to a mental health practitioner.

Like Headspace, My Circle is an online space where vulnerable young people can feel safe, are able to support each other, benefit from psychoeducation and engage in counsellor moderated discussions on a swathe of ‘edgy’ topics. Dedicated counsellors have a minimal but important role in My Circle. Kids Helpline (kidshelpline.com.au) developed this social media platform for 13 to 25-year-olds. Campbell et al. (2019) describe how qualitative and quantitative feedback coming from both participants and counsellors in the trial process informed site design and participants’ experiences.

Counselling with digital technology

In summary, while a plethora of research reveals the negative effects of DCT on culture and the journey of the self through life, a simple fact is that ‘the genie is out of the bottle’ and many clients and counsellors benefit from using face-to-face video technologies and online psychoeducation courses. DCT makes counselling accessible to more people – for example, those who are time or mobility restricted or who live in regional or remote areas. For digital natives and others, developments – such as counselling sessions where the client and therapist don avatar personas in 3D virtual worlds – may have great appeal and bring therapeutic benefits.

Balick (2014) points out that DCT is essentially transferring information, so is neither inherently good nor bad. It is also true that real benefits and dangers confront everyone. The emotional fallout of online bullying in social media, the danger of social media addiction, the implications of posts lasting into digital infinity or being reposted, and the porosity of online confidentiality, come immediately to mind. Considering these and other DCT dangers is vital if we and clients are to stay safe and we are to meet client needs. Counselling in this DCT-saturated world still requires helpful boundaries, trust and rapport, and being aware of power issues. The question becomes: “How do we navigate with and around DCT devices and their offerings, so that our clients and ourselves benefit?”

DCT is with us, offering much, but lets us navigate with creativity, curiosity and caution, so to facilitate the needs of the unfolding relational self. ■

About the author

Julie Cunningham is Student Member of a ACA, and a visual artist.

References

Andreassen C.S., Torsheim T., Brunborg G.S., Pallesen S. (2012) Development of a Facebook addiction scale 1, 2. Psychological Reports, 110(2), 501–17

Balick, A. (2014). Technology, social media, and psychotherapy: Getting with the programme. Contemporary Psychotherapy, 6(2).

Ballesteros S., Mayas J., Prieto A., Toril P., Pita C., Ponce de Leon, P., Reales, J. M., Waterworth, J. A. (2015) A randomized controlled trial of brain training with non-action video games in older adults: results of the 3-month follow-up.

Front Aging Neurosci. 7(45). doi.org/10.3389/fnagi.2015.00045.

Ball K., Berch D.B., Helmers K.F., Jobe J, B., Leveck MD, Marsiske M., Morris, J., Rebok, G. W., Smith, D. M., Tennstedt, S. L., Unverzagt, F.

W., Willis, S. L. (2002) Effects of cognitive training interventions with older adults: a randomized controlled trial. Jama, 288(18), 71–81. ncbi.nlm.nih.gov/pubmed/12425704.

Bankmycell. bankmycell.com/blog/how-manyphones-are-in-the-world

Bányai, F., Zsila, Á., Király, O., Maraz, A., Elekes, Z., Griffiths, M. D., Andreassen, C. S., & Demetrovics, Z. (2017). Problematic Social Media Use: Results from a Large-Scale Nationally Representative Adolescent Sample. PloS one, 12(1). doi.org/10.1371/journal.pone.0169839

Bhattacharya, S., Bashar, M. A., Srivastava, A., Singh, A. (2019). NOMOPHOBIA: NO MObile PHone PhoBIA. Journal of family medicine and primary care, 8(4), 1297–1300. doi.org/10.4103/jfmpc.jfmpc_71_19

Bion, W.R. (1962). Learning From Experience. Karnac Books

Botella C., Etchemendy E., Castilla D., Baños R.M., García-Palacios A., Quero S., Alcañiz, M., Lozano, J. A. (2009) An e-health system for the elderly (Butler project): a pilot study on acceptance and satisfaction.

Cyber Psychology Behaviour, 12(3), 255–62. doi.org/10.1089/cpb.2008.0325.

Brailovskaia, J., Margraf, J. (2017). Facebook Addiction Disorder (FAD) among German students-A longitudinal approach. PloS one, 12(12). doi.org/10.1371/journal.pone.0189719

Campbell A., Ridout B., Amon K., Navarro P., Collyer B., Dalgleish J. (2019) A Customized Social Network Platform (Kids Helpline Circles) for Delivering Group Counselling to Young People Experiencing Family Discord That Impacts Their Well-Being: Exploratory Study.

Journal of Medical Internet Research, 21(12). jmir.org/2019/12/e16176

Cozolino, L. (2006). The Neuroscience of human relationships: Attachment and the developing social brain. W. W. Norton.

Cundy, L. (2015). Attachment, selfexperience, and communication technology: love in the age of the internet. In L. Cundy (Ed.), Love in the age of the internet: Attachment in the digital era (pp.1-29). Karnac Books.

Curtis, A. (Writer and Producer). (2002). The Century of the Self.

British Broadcasting Corporation.

Data Reportal. datareportal.com/reports/digital-2022-april-globalstatshot

Firth J., Torous J., Nicholas J., Carney R., Rosenbaum S., Sarris J. (2017) Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15-22. doi.org/10.1016/j.jad.2017.04.046.

Headspace. headspace.org.au

Heidegger, M. (1977) The question concerning technology (W. Lovitt, Trans.) The question concerning technology: and other essays (pp.3-35).

Jones, C. M., Scholes L., Johnson D., Katsikitis M., Carras M. C. (2014) Gaming well: links between videogames and flourishing mental health. Frontiers in Psychology. doi.org/10.3389/fpsyg.2014.00260

Kaluzeviciute, G. (2020). Social Media and its Impact on Therapeutic Relationships. British Journal of Psychotherapy, 36, 303-320. https://doi.org/10.1111/bjp.12545.

Kidshelpline. kidshelpline.com.au/my-circle

Maheshwari, S. & Hopuch, A. (2023) Why countries are trying to ban Tik Tok. New York Times. nytimes.com/article/tiktok-ban.html

Mirelman, A., Rochester, L., Reelick, M., Nieuwho,f F., Pelosin, E., Abbruzzese, G. (2013) V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomised controlled trial. BMC Neurology, 13(1). doi.org/10.1186/1471-2377-13-15.

Lembke, A. (2021). Dopamine Nation: Finding balance in the age of indulgence. Penguin Putnam

Nicoli, L. (2015). The seduction of digital magic. In J. S. Scharff (Ed.), Psychoanalysis online 2: Impact of technology on development, training, and therapy (pp. 29–37). Karnac Books.

Optale, G., Urgesi, C., Busato, V., Marin, S., Piron, L., Priftis, K., Gamberini, L. Capodieci, S, Bordin, A. (2009) Controlling memory impairment in elderly adults using virtual reality memory training: randomized controlled pilot study. Neurorehabilitation Neural Repair, 24(4), 348-357. doi.org/10.1177/1545968309353328.

Prensky, M. (2001) Digital Natives, Digital Immigrants. On the Horizon, 9(5), MCB University Press.

Pedram, S., Palmisano, S., Perez, P., Mursic, R., Farrelly, M. (2020) Examining the potential of virtual reality to deliver remote rehabilitation. Computers in Human Behaviour, 105. doi.org/10.1016/j.chb.2019.106223.

Shahnawaz, M. G., Rehman, U. (2020) Social Networking Addiction Scale. Cogent Psychology, 7(1). doi:10.1080/ 23311908.2020.1832032

Shambare, R. (2012). Are mobile phones the 21st century addiction? African Journal of Business Management.

Stadter, M. (2013). The influence of social media and communication technology on self and relationships. In: J. S. Scharff, (Ed.). Psychoanalysis Online: Mental Health, Teletherapy, and Training, (pp. 3–13) Karnac Books.

Suler, J. 2004. The online disinhibition effect. CyberPsychology & Behavior, 7(3). doi.org/10.1089/1094931041291295

Toril, P., Reales, J. M., & Ballesteros, S. (2014). Video game training enhances cognition of older adults: A meta-analytic study. Psychology and Aging, 29(3), 706–716. doi.org/10.1037/a0037507

Torrens University Australia. (2020). Trevor Armitage: Online group counselling (Video.)

Torres, A. (2008). Cognitive effects of videogames on older people. International Conference Series on Disability, Virtual Reality and Associated Technologies. icdvrat.org

Turner, W. A., Casey, L. M. (2014) Outcomes associated with virtual reality in psychological interventions: where are we now? Clinical Psychology Review, 34(8) 634–44. doi.org/10.1016/j.cpr.2014.10.003

Vailati Riboni, F., Comazzi, B., Bercovitz, K., Castelnuovo, G., Molinari, E., Pagnini, F. (2020), Technologically enhanced psychological interventions for older adults: a scoping review. BMC Geriatrics, 20, article 191. doi.org/10.1186/s12877-020-01594-9

van den Eijnden R.J., Lemmens J.S., Valkenburg P.M. (2016) The Social Media Disorder Scale: Validity and psychometric properties. Computers in Human Behavior, 61, 478–87

Walsh, S. P., White, K. M. (2007) Me, my mobile and I: The role of self and prototypical identity influences in the prediction of mobile phone behaviour.

Journal of Applied Social Psychology, 37, 2405–2434

Walters, J. (21) Constant craving: how social media has turned us all into dopamine addicts. The Guardian. theguardian.com/global/2021/aug/22/how-digital-media-turned-us-all-into-dopamine-addicts-and-what-we-can-do-to-break-the-cycle

Wearesocial.com.au/blog/2022/02/digital-2022-australia-online-like-never-before

Weightman, M. (2020). Digital psychotherapy as an effective and timely treatment option for depression and anxiety disorders: Implications for rural and remote practice. Journal of International Medical Research, 48(6), 1-7

Weinberg, H. (2014). The paradox of internet groups: Alone in the presence of virtual others. Routledge.

Winnicott, D. W. (1965a) Ego distortion in terms of true and false self. In: The Maturation Process and the Facilitating Environment (pp.140-152), Karnac Books.

Young K. (1999) Internet addiction: Evaluation and treatment. Student British Medical Journal, 7, 351–352

Young K. (2009) Facebook Addiction Disorder? The Center for Online Addiction; Bradford, PA, USA.